Impact of the use of anti-diabetic drugs on survival of diabetic dialysis patients: a 5-year retrospective cohort study in Taiwan

Po Jen Hsiao, Kun Lin Wu, Szu Han Chiu, Jenq Shyong Chan, Yuh Feng Lin, Chung Ze Wu, Chia Chao Wu, Sen Yeong Kao, Te Chao Fang, Shih Hua Lin, Jin Shuen Chen

研究成果: 雜誌貢獻文章

2 引文 (Scopus)

摘要

Background: Type 2 diabetes mellitus (DM) and associated complications are common in patients with chronic kidney disease (CKD) and can increase morbidity and mortality. A longitudinal 5-year observational study was conducted to investigate whether the use of anti-diabetic medications or not affected survival rates of diabetic dialysis patients. Methods: Using a data sample of a million patients from Taiwan’s National Health Insurance Database, a retrospective cohort study surveyed patients with type 2 DM who began dialysis between 2002 and 2007. The study population was classified into groups using or not using anti-diabetic drugs. The group using anti-diabetic drugs was then categorized into 3 subgroups, including use of only oral hypoglycemic agents (OHAs), only insulin, and OHAs-combined insulin groups. Subjects of these four groups were followed 5 years or to date of death. Three major areas were analyzed: (1) demographic data and medical history; (2) survival prognosis and causes of death; and (3) effects on survival prognosis of different classes of OHAs. Results: A total of 912 patients fitting inclusion criteria were enrolled and followed-up for 5 years or to date of death. A total 465 patients died, and those not using anti-diabetic drugs (67.34 %) had a higher mortality rate than those using anti-diabetic drugs (46.42 %). After the multivariate analysis, group of OHAs-combined insulin had the lowest risk of death (HR 0.36, 95 % CI 0.27–0.47), followed by OHAs alone (HR 0.49, 95 % CI 0.38–0.63) and then insulin alone (HR 0.67, 95 % CI 0.51–0.88). To clarify four classes of OHAs (sulfonylurea, α-glucosidase inhibitors, meglitinide, and thiazolidinedione) are used in Taiwan for uremia patient with type 2 DM, and in our study, there were no significant differences in survival prognosis for the four drugs. Finally, the most common cause of death was infectious disease and there were no significant differences among the four groups. Conclusion: This 5-year observational study results suggested that diabetic dialysis patients with anti-diabetic drugs had a lower risk of death compared with those without anti-diabetic drugs. Despite insulin therapy, appropriate OHAs should play an important role in treating these patients.
原文英語
頁(從 - 到)694-704
頁數11
期刊Clinical and Experimental Nephrology
21
發行號4
DOIs
出版狀態已發佈 - 八月 1 2017

指紋

Taiwan
Dialysis
Cohort Studies
Retrospective Studies
Hypoglycemic Agents
Survival
Pharmaceutical Preparations
Insulin
Type 2 Diabetes Mellitus
Observational Studies
Cause of Death
Glucosidases
Mortality
Uremia
National Health Programs
Chronic Renal Insufficiency
Communicable Diseases
Multivariate Analysis
Survival Rate
Demography

ASJC Scopus subject areas

  • Physiology
  • Nephrology
  • Physiology (medical)

引用此文

Impact of the use of anti-diabetic drugs on survival of diabetic dialysis patients : a 5-year retrospective cohort study in Taiwan. / Hsiao, Po Jen; Wu, Kun Lin; Chiu, Szu Han; Chan, Jenq Shyong; Lin, Yuh Feng; Wu, Chung Ze; Wu, Chia Chao; Kao, Sen Yeong; Fang, Te Chao; Lin, Shih Hua; Chen, Jin Shuen.

於: Clinical and Experimental Nephrology, 卷 21, 編號 4, 01.08.2017, p. 694-704.

研究成果: 雜誌貢獻文章

Hsiao, Po Jen ; Wu, Kun Lin ; Chiu, Szu Han ; Chan, Jenq Shyong ; Lin, Yuh Feng ; Wu, Chung Ze ; Wu, Chia Chao ; Kao, Sen Yeong ; Fang, Te Chao ; Lin, Shih Hua ; Chen, Jin Shuen. / Impact of the use of anti-diabetic drugs on survival of diabetic dialysis patients : a 5-year retrospective cohort study in Taiwan. 於: Clinical and Experimental Nephrology. 2017 ; 卷 21, 編號 4. 頁 694-704.
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title = "Impact of the use of anti-diabetic drugs on survival of diabetic dialysis patients: a 5-year retrospective cohort study in Taiwan",
abstract = "Background: Type 2 diabetes mellitus (DM) and associated complications are common in patients with chronic kidney disease (CKD) and can increase morbidity and mortality. A longitudinal 5-year observational study was conducted to investigate whether the use of anti-diabetic medications or not affected survival rates of diabetic dialysis patients. Methods: Using a data sample of a million patients from Taiwan’s National Health Insurance Database, a retrospective cohort study surveyed patients with type 2 DM who began dialysis between 2002 and 2007. The study population was classified into groups using or not using anti-diabetic drugs. The group using anti-diabetic drugs was then categorized into 3 subgroups, including use of only oral hypoglycemic agents (OHAs), only insulin, and OHAs-combined insulin groups. Subjects of these four groups were followed 5 years or to date of death. Three major areas were analyzed: (1) demographic data and medical history; (2) survival prognosis and causes of death; and (3) effects on survival prognosis of different classes of OHAs. Results: A total of 912 patients fitting inclusion criteria were enrolled and followed-up for 5 years or to date of death. A total 465 patients died, and those not using anti-diabetic drugs (67.34 {\%}) had a higher mortality rate than those using anti-diabetic drugs (46.42 {\%}). After the multivariate analysis, group of OHAs-combined insulin had the lowest risk of death (HR 0.36, 95 {\%} CI 0.27–0.47), followed by OHAs alone (HR 0.49, 95 {\%} CI 0.38–0.63) and then insulin alone (HR 0.67, 95 {\%} CI 0.51–0.88). To clarify four classes of OHAs (sulfonylurea, α-glucosidase inhibitors, meglitinide, and thiazolidinedione) are used in Taiwan for uremia patient with type 2 DM, and in our study, there were no significant differences in survival prognosis for the four drugs. Finally, the most common cause of death was infectious disease and there were no significant differences among the four groups. Conclusion: This 5-year observational study results suggested that diabetic dialysis patients with anti-diabetic drugs had a lower risk of death compared with those without anti-diabetic drugs. Despite insulin therapy, appropriate OHAs should play an important role in treating these patients.",
keywords = "Anti-diabetic drugs, Diabetes mellitus, Dialysis, Insulin, Oral hypoglycemic agents, Survival",
author = "Hsiao, {Po Jen} and Wu, {Kun Lin} and Chiu, {Szu Han} and Chan, {Jenq Shyong} and Lin, {Yuh Feng} and Wu, {Chung Ze} and Wu, {Chia Chao} and Kao, {Sen Yeong} and Fang, {Te Chao} and Lin, {Shih Hua} and Chen, {Jin Shuen}",
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T1 - Impact of the use of anti-diabetic drugs on survival of diabetic dialysis patients

T2 - a 5-year retrospective cohort study in Taiwan

AU - Hsiao, Po Jen

AU - Wu, Kun Lin

AU - Chiu, Szu Han

AU - Chan, Jenq Shyong

AU - Lin, Yuh Feng

AU - Wu, Chung Ze

AU - Wu, Chia Chao

AU - Kao, Sen Yeong

AU - Fang, Te Chao

AU - Lin, Shih Hua

AU - Chen, Jin Shuen

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background: Type 2 diabetes mellitus (DM) and associated complications are common in patients with chronic kidney disease (CKD) and can increase morbidity and mortality. A longitudinal 5-year observational study was conducted to investigate whether the use of anti-diabetic medications or not affected survival rates of diabetic dialysis patients. Methods: Using a data sample of a million patients from Taiwan’s National Health Insurance Database, a retrospective cohort study surveyed patients with type 2 DM who began dialysis between 2002 and 2007. The study population was classified into groups using or not using anti-diabetic drugs. The group using anti-diabetic drugs was then categorized into 3 subgroups, including use of only oral hypoglycemic agents (OHAs), only insulin, and OHAs-combined insulin groups. Subjects of these four groups were followed 5 years or to date of death. Three major areas were analyzed: (1) demographic data and medical history; (2) survival prognosis and causes of death; and (3) effects on survival prognosis of different classes of OHAs. Results: A total of 912 patients fitting inclusion criteria were enrolled and followed-up for 5 years or to date of death. A total 465 patients died, and those not using anti-diabetic drugs (67.34 %) had a higher mortality rate than those using anti-diabetic drugs (46.42 %). After the multivariate analysis, group of OHAs-combined insulin had the lowest risk of death (HR 0.36, 95 % CI 0.27–0.47), followed by OHAs alone (HR 0.49, 95 % CI 0.38–0.63) and then insulin alone (HR 0.67, 95 % CI 0.51–0.88). To clarify four classes of OHAs (sulfonylurea, α-glucosidase inhibitors, meglitinide, and thiazolidinedione) are used in Taiwan for uremia patient with type 2 DM, and in our study, there were no significant differences in survival prognosis for the four drugs. Finally, the most common cause of death was infectious disease and there were no significant differences among the four groups. Conclusion: This 5-year observational study results suggested that diabetic dialysis patients with anti-diabetic drugs had a lower risk of death compared with those without anti-diabetic drugs. Despite insulin therapy, appropriate OHAs should play an important role in treating these patients.

AB - Background: Type 2 diabetes mellitus (DM) and associated complications are common in patients with chronic kidney disease (CKD) and can increase morbidity and mortality. A longitudinal 5-year observational study was conducted to investigate whether the use of anti-diabetic medications or not affected survival rates of diabetic dialysis patients. Methods: Using a data sample of a million patients from Taiwan’s National Health Insurance Database, a retrospective cohort study surveyed patients with type 2 DM who began dialysis between 2002 and 2007. The study population was classified into groups using or not using anti-diabetic drugs. The group using anti-diabetic drugs was then categorized into 3 subgroups, including use of only oral hypoglycemic agents (OHAs), only insulin, and OHAs-combined insulin groups. Subjects of these four groups were followed 5 years or to date of death. Three major areas were analyzed: (1) demographic data and medical history; (2) survival prognosis and causes of death; and (3) effects on survival prognosis of different classes of OHAs. Results: A total of 912 patients fitting inclusion criteria were enrolled and followed-up for 5 years or to date of death. A total 465 patients died, and those not using anti-diabetic drugs (67.34 %) had a higher mortality rate than those using anti-diabetic drugs (46.42 %). After the multivariate analysis, group of OHAs-combined insulin had the lowest risk of death (HR 0.36, 95 % CI 0.27–0.47), followed by OHAs alone (HR 0.49, 95 % CI 0.38–0.63) and then insulin alone (HR 0.67, 95 % CI 0.51–0.88). To clarify four classes of OHAs (sulfonylurea, α-glucosidase inhibitors, meglitinide, and thiazolidinedione) are used in Taiwan for uremia patient with type 2 DM, and in our study, there were no significant differences in survival prognosis for the four drugs. Finally, the most common cause of death was infectious disease and there were no significant differences among the four groups. Conclusion: This 5-year observational study results suggested that diabetic dialysis patients with anti-diabetic drugs had a lower risk of death compared with those without anti-diabetic drugs. Despite insulin therapy, appropriate OHAs should play an important role in treating these patients.

KW - Anti-diabetic drugs

KW - Diabetes mellitus

KW - Dialysis

KW - Insulin

KW - Oral hypoglycemic agents

KW - Survival

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